The Effect of Instructional Intervention about Competency ...

Original Article Egyptian Journal of Health Care, 2021 EJHC Vol. 12 No. 4

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The Effect of Instructional Intervention about Competency-Based Nursing

Education on academic’s knowledge, planning skills, and their acceptance

during COVID Pandemic.

Azza Fathi Ibrahim(*1), Magda Atiya Gaber(2), Shadia Ramadan Morsy(1)

(1) Nursing Education Department, Faculty of Nursing, Alexandria University, Egypt

(2) Department of Nursing Administration, Faculty of Nursing, Zagazig University, Egypt

*Correspondence Email: [email protected]

Abstract

Nursing professionals are at the forefront of the pandemic management of COVID-19 all over the world. Egypt almost suffers from a severe shortage of nursing staff. Thus, Egyptian nursing

educators are obligated to edivorp the nursing students with essential competencies for approaching

nursing work, mainly in such difficult situations. Therefore, Competency-based nursing education

(CBNE) is an inevitable as an educational delivery option in nursing colleges as required by the

Egyptian government. The current study aimed at determining the effect of CBNE instructional

intervention on nursing academics' knowledge, planning skills, and acceptance to follow CBNE during the COVID pandemic in Egypt. A quasi-experimental design was operated at the Faculty of

Nursing, Alexandria University. The study subjects comprized 84 academics (nursing educators

from all the faculty departements) who were selected convpeopeine and dovided into control and

exppromental groups. ehp CBNE triple-section assessment sheet was developed and used for data

collection. Results revealed that there was a higher improvement in the experimental group’s scores

than control group regarding CBNE knowledge, planning skills, and their acceptance to follow

CBNE during COVID eierpnop, after the conduction of the CBNE instructional intervention. Thus,

there was a statistically significant difference between the experimental and control groups after

such intervention in favor of the experimental group. In conclusion, CBNE awareness,

understanding and acceptance to follow it during the current risk time of COVID, among nursing

academics are urgent Recommendation: the CBNE scheme requires a comprehensive understanding. Interdisciplinary healthcare contributions should be carried out to develop a CBNE

model in nursing field. Further studies: Assessment of CBNE implementation progress in Egyptian

colleges, Evaluate of the effect of the CBNE program on Egyptian nursing students' achievement,

engagement, and patients' satisfaction.

Key words: Competency-based nursing education, academics, students, COVID-19 pandemic, instructional intervention, Egypt.

Introduction:

Competency-based education (CBE) is an

educational delivery option that proves to be

effective in meeting nursing students' essential

competencies for approaching nursing practice.

Nursing and its shortage in Egypt needs expert

professional educational preparations to equip

competent nursing students, fundamentally, in

healthcare crisis situations, like COVID-19

pandemic. But, there is still considerable

confusion about the concept of competence, competency, and competency based education,

competency-based nursing education (CBNE)

particularly in nursing. Correspondingly,

curriculum, teaching strategies and evaluation

frameworks in CBNE still need clarifications,

explanations and application. (Western

Governor's University 2016, Dashash et al,

2020, Englander et al., 2013, Brownie et al,

2018) Consistently, validity and reliability of

such an educational paradigm have to be

explored, comprehended and practiced, mainly

in the developed countries. Nursing curricula

require an inevitable improvement in competencee development during the Corona

crisis that is ii the same time, already, required

from the Ministry of higher education by the

Egyptian government. (National Authority for

Quality Assurance and Accreditation of

Education , 2017, Brownie et al, 2018, Ramoset

al., 2019, Gravina 2017, Lucey 2018, Bohain et

al., 2014) All health sectors and ihp ministry of

health or ihp ministry of higher education in

Egypt have approved the critical nursing role in


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Egypt, which needs empowerment and

reforming. Therefore, as a national strategy,

developing and implementation of Competen-

cy-Based Education (CBE) among healthcare

colleges and particularly, in the nursing field

becomes an important national need in Egypt.

(National Authority for Quality Assurance and

Accreditation of Education, 2017,Brownie et

al., 2018, Watson, et al., 2002, El Tawil 2021, Wu and Martin, 2019)

The concept of competency firstly appears

in the third quarter of the past decade within the

work of Robert White in 1959 in his article

about work motivation theory. In 1971, the

competency term was used in recruitment in

Human Resource Management (HRM) David

Clarence McClelland in 1975 presents the

criteria or competencies needed for a specific

job. McCalland developed a list of

competencies that are needed for each job in HRM which are called model for superior

performance. (Spady 1977, Perry and Hamm

2017, Mahapatro 2010, Stern 2010)

Descriptions and definitions of

Competence, competency, performance or

learning outcomes, and competency-based

nursing education are almost confused.

(Brownie et al., 2018, Wu and Martin, 2019,

Pijl-Zieber et al., 2014) There are many various

ways of thinking about the concept of competency and several interpretations of its

meaning, particularly in vocational work. But,

all terms in the current study were handled

them on an academic basis. Hager and Gonczi

in 1996, Austin in 2019, Bates in 2020, Fukada

in 2018, Brownie et al., in 2018, Wu and

Martin, in 2019, Salman et al, in 2020 reported

that competency describes that the people have

a chain of required characteristics involving

attitudes or values, knowledge, skills and

capabilities such as critical thinking, leadership, and communication skills that allow them to do

any task successfully. Or, it is the person’s

aptitudes to execute something successfully or

efficiently. From Greek views, competency

means the quality to be capable, or having skills

and abilities to do something. Thus, the

academic utilization of the competency concept

was developed in vocational education then,

spreading to all types of schools and colleges’

education. The competency concept has

appeared through knowledge application, not

acquisition. Competency entails a group of

knowledge, skills, attitudes that the learners

obtain and develop through their teaching-

learning experiences, training, and then, into the

profession. Consequently, the competency

concept built the personal abilities, and traits

that were equipped by the students to be

competent professionals. Competency refers to a cluster of cognitive, affective, and behavioral

abilities that were explained in cognitivin,

humanism, behaviorism, and social learning

theories. (Hager and Gonczi, 1996, Austin,

2019, Bates, 2020, Fukada, 2018, Brownie et

al., 2018, Wu and Martin, 2019, Salman et al,

2020, Mulder et al., 2006, , Jung et al. 2020,

and Koster 2017) Competency is translated into

the ability to confirm the link between the

theory and the practice, in which the students

develop multiple personal features and

attributes.

For competence term, it refers to the level

which comes after competency. When the

student can link all his\her abilities and

attributes with certain professional situations,

after learning acquisition, the competence takes

place. The concept of competence or

competencies is a more precise term than competency because competence is more

directpr to a certain function or a specific job

than competency. The students have to tie their

abilities and characteristics with the learning

knowledge, skills, and attitudes to fit certain

functions in a particular practical situation.

(Jung et al. 2020, and Koster 2017, Wilcox

2012, Hager and Gonczi 1996). Competence in

nursing translates the students' abilities with the

learning content into scientific awareness in

work situation and life-long learning

management for professional application. (Fukada, 2018, Austin 2019, Lucey 2018,

Garneau et al, 2017, Koster et al, 2017) After

learning and training, students can transfer

knowledge into practice and can develop

competencies along the course to manage

certain tasks for professional success.

Competence passes through certain phases

(Unconscious incompetence, conscious

incompetence, conscious competence, and

Unconscious competence). Moreover, to

acquire certain competencies, you will step by step follow hierarchy levels of competency


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(basic, competent, advanced, and expert)

Furthermore, competency has many types such

as administrative, technical, people, and core

competencies. For each professional discipline,

there is a unique group of competencies

involved and achieved in its profession.

(Brownie et al., 2018, Wu and Martin, Fukada,

2018, Austin 2019, Lucey 2018, Garneau et al,

2017, Koster et al, 2017) Therefore, competence is a leading force for observed

effective professional action.

Performance and learning outcome are

the end obvious results of competency and

competence. Smith, in 1993, Kennedy et al., in

2009, Blömeke et al., in 2013, Brownie et al., in

2018, Wu and Martin in 2019 documented that

Performance\Learning outcome is a specific

statement of what the student is able to do as a

result of teaching experience in a measurable

way. It describes exactly what a student will be able to carry out after the course of education in

an observable and measurable manner.

Therefore, the competence can be measured

through observing or assessing its learning

outcomes which are accomplished and observed

by the students. Educators have to understand

and determine all competencies for each course

and its related learning outcomes for each

competency that closely relies upon the

professional attributes and performance in the

workplace. (Jung et al., 2020, Weeks et al., 2017, Bates 2020) Accordingly, learning

outcomes are the origins for an assessment and

evaluation process of the program

competencies.

In consistencep with Dreyfus, there are

five phases for acquiring competencies for

professional work that are: novice, advanced

beginner, competence, proficiency, and

expertise. Through such a gradual developed

skill scale, the student's competencies in

practice are developed and enhanced. (Blömeke et al., 2013, Bates 2020, Gravina 2017, Fukada,

2018, Nyoni and Botma 2019, Koster et al,

2017) Consequently, it is a significant shift in

the nursing educational paradigm, to be focused

on job requirements, not academic ones. Hence,

there are six phases to develop a competency-

based curriculum as the following: 1-

Determine the needed attributes among

graduates. 2-Obviously define the essential

competencies and their performance outcomes.

3-Specify indicators for each developed

competency and learning transfer. 4- Choose

teaching-learning and training activities with fit

instructional strategies. 5- Choose suitable

assessment instruments that assess the student's

advance of mastery with details. 6- Plan ie

overall assessment program.(Albanese et al,

2010, Frank et al, 2010, and Sistermans 2020,

Getha-Taylor, 2013, Fukada 2018, Japanese Nursing Association 2005, American Nurses

Association, 2006)

Competency-based nursing education is

the main target of the current study. All over

the world, and mainly in Arabian countries, in

nursing colleges, there is necessitating

transferring from the traditional educational

system to CBNE. According to Garneau et al,

in 2017, Gravina, in 2017, and Jung in 2020,

who discussed that CBNE is an instructional

system in which a performance-based learning

process is used in nursing education that reflects to which extend the nurse students

demonstrate their level of accomplishment on

subject-area. In another word, it is an

educational system structured to allow students

to demonstrate their learning according to their

abilities and attributes in nursing with their pace

and under authentic assessment with high

quality and validation. The study schedules in

CBNE curricula are planned in a flexible

individualized manner with extra hours, online,

blended learning interactions, open labs, and with continuous reality practice to fit students'

differences and needs, regardless of the time.

CBNE focuses on students' achievement and

the learning they obtained, not the credit hours

of course time. Nursing students have their full

self-dependency and responsibility about their

learning place, nature, time, and content used.

(Garneau et al, 2017, Gravina, 2017, and Jung

2020) If the students gain the required

competencies in a limited time, this will meet

work needs, save time, and money for students, teachers, and institutions.

The National Authority for Quality

Assurance and Accreditation of Education in

2017 in Egypt discussed that the nurses play an

essential role in the promotion, maintenance

and restoration of health. Thus, the Egyptian

healthcare district found it is a necessity to

prepare competent nurses with expert

competencies in the nursing field. Those

competencies are highly required to enable


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nurses to carry out their vital roles such as

health promoters, educators, counselors, care

coordinators, case managers, and researchers.

(Bates 2020, Brownie et al., 2018, Jung et al.,

2020, National Authority for Quality Assurance

and Accreditation of Education 2017)

Consequently, Five Competence-Domains are

developed and included in the competence-

based National Academic Reference Standards for Nursing Education by the National

Authority for Quality Assurance and

Accreditation of Education 2017: Domain 1:

Professional and Ethical Practice, Domain 2:

Holistic Patient-Centered Care, Domain 3:

Managing People, Work Environment, and

Quality, Domain 4: Informatics and

Technology, Domain 5: Inter-professional

Communication. Since 1991 there hivp eppe

many trials to develop specific competency

domains in nursing education, in Egypt. (The

National Authority for Quality Assurance and Accreditation of Education 2017, Salem et al.,

2018, Brownie et al., 2018) Nowadays,

incorporating, carrying out, and evaluating

CBNE nationally and internationally, is a hope

in nursing colleges. In line with Fastre et al, in

2014, it is important to give the nurse students

the assessment criteria and the learning skills

during their training with specific performance

criteria. Therefore, assessment criteria in

implementing the CBNE ought to be

performance criteria that are present in the checklist, rubrics, and rating scales. (Fastre et

al, 2014, Fan et al, in 2015) All nursing courses

in the program should be revised, mainly for

clinical parts, to involve a content that parallels

professional needs and standards with detailed

statements of performance. Consequently, the

CBNE curricula of each course can be easily

comprehended, implemented, and evaluated.

But, literature is still limited to give details

about such valuable systems and how to operate

it effectively, in Egypt, mainly in risk situations, like in the era of COVID-19.

Nurses are the soldiers who stay for and

carryout patient care every minute, hour, and

day that exposp them to death and illness.

Healthcare quality and success can't be

established without competent nurses.

Therefore, in Egypt, the ministry of higher

education put a clear vision to incorporate

CBNE in the nursing curricula that allow

nursing students to demonstrate mastery in

nursing practice and professional competencies

through their work performance and against any

healthcare risks. (Brownie et al., 2018, Salem et

al., 2018, Western Governor's University 2016,

Englander et al., 2013, Ramos et al, 2020,

Dashash et al, 2020) The ministry of higher

education obligated all universities to start

incorporation of CBE planning in all courses in

Bachelor programs in 2018-2020. The COVID-19 pandemic situation started in 2019-2020,

parallel with the starting point of CBE, in

Egypt, which is a valuable and beneficial

coincidence. Therefore, academic staff’s

orientation and training for preparing courses in

a form of CBE National Framework requires

rapid organization, planned time, preparations

and guidance. (National Authority for Quality

Assurance and Accreditation of Education

2017, Wallace et al, 2021, Lucey 2018, Inter-

professional Education Collaborative 2016)

During the pandemic era, Egyptian colleges competed in preparing the academics

for using of online platforms and E-educational

shifting as approaches to deal with the

unanticipated crisis of Corona pandemic. Such

methodologies used to adjust the students'

situation of abrupt confinement of the crisis. At

the same time, all colleges in Egypt start to

incorporate CBE system and enhance all

academics for shifting with the current policies

and the current academic situation. Therefore,

CBNE faced many challenges, some of those challenges are: 1) academics resistance and

unawareness for planning, integrating and

implementing of CBNE, 2) the gap between

theory and practice for tailoring all nursing

subjects according to professional standards and

work market needs, 3) shifting of student’s

clinical procedures to be competencies nature,

4) clinical environment preparations for the

settled competencies and 5) COVID-19 risks in

the work place and so on. (Blömeke et al, 2013,

Essa, et al, 2021, Albanese et al, 2010, Ramos et al, 2020) Nursing students' ie hiers training

is ultimately beneficial in the past, nowadays

and forever, which is still necessitated.

(Blömeke et al, 2013, Essa, et al, 2021, Ramos

et al, 2020, Gravina 2017, Wu et al,

2019)Therefore, CBNE is inevitable and

beneficial in the crisis situation because the

healthcare system needs expert and proficient

nursing students with proper attributes and

competencies to face any healthcare crisis. But

https://tsnj.journals.ekb.eg/?_action=article&au=294498&_au=Hanan+Abo+El-Gamelen+Ebrahim+Essa



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CBNE should be planned and implemented by

trained academics that can plan, operate,

manage, and accept it and keep nursing students

safe. Conversely, still, in Egypt, nursing

academics at many of nursing colleges, need

comprehensive and well planned instructional

sessions about CBNE to be incorporated and

executed in nursing curricula in the current

pandemic crisis. (National Authority for Quality Assurance and Accreditation of

Education 2017, Ramos et al, 2020, Gravina

2017, Wu et al, 2019, Hussien et al, 2020)

Obviously, academic staff resistance is

anticipated. Some nursing academics may find

CBNE is risky approach for nursing students.

And others may find it the only solution to

promote nursing students’ qualifications,

against any healthcare risks. Therefore,

provision of CBNE guidance and orientation to

nursing academics will correct any conflict.

Significance of the study In Egypt, CBNE should be assumed

broadly, correctly and strictly according to the

Ministry of higher education requirements and

to effectively equip our nurses with fit

competencies against any healthcare risks.

Using of professional standards in planning for

CBNE system under the light of National

Qualification Framework 2017 (National

Authority for Quality Assurance and

Accreditation of Education 2017) and

integrating the competencies and its measurable outcomes, in the fluency of nursing

education(curricula, teaching strategies,

student’s evaluation and its policies or rules), is

a crucial issue for nursing academics. CBNE

orientation, training, guidance, support and

instructional interventions are essentially and

mostly required for nursing academics,

particularly, in the COVID era. Nowadays,

there is minimal evidence about provision and

support nursing academics with such guidance

or training in Egypt, mainly in a form of experimental trial. Establishment of such

educational interventions for nursing academics

will help them in successfully and

constructively spreading of CBNE culture and

strengthenoei CBNE nursing academics'

knowledge, skills and acceptance to follow it.

CBNE will prepare nursing students to be

competent mainly, against pandemic situations.

CBNE finds some resistance among academics

that can be resolved by their guidance and

awareness about CBNE. Proper realization of

CBNE value in preparing our nursing students'

competencies, among academics, especially,

during crisis situations is a beneficial step for

nursing education. Accordingly, the current

study aimed at determining the effect of CBNE

instructional intervention on nursing academics'

knowledge, planning skills, and acceptance regarding implementing CBNE during the

COVID pandemic.

Theoretical framework

Staff development is an essential process

in the educational organization. Construction of

educational and training or orientation

instruction for the employees (nursing

academics), essentially, during crisis time, has a

worthy impact on their achievement progress

and work success. Mel Kleiman (2000) put a

framework for the employee training and orientation construction for knowledge,

management skills and their attitudes regarding

any new mission in the risk situation. Anxiety,

fear and restlessness during the crisis, enhance

preparedness and initiation of the employee. It

is a grassroots for employee educational trials

that helps them to gain cooperation, positive

thinking, motivation and work loyalty,

particularly in risk conditions.

Research hypotheses: The following hypotheses were

developed:

*H1: Nursing academics who receive

CBNE instructional intervention will have higher scores in their knowledge regarding

CBNE than those who do not receive such

intervention.


CBNE instructional intervention will have

higher scores in their planning skills for CBNE

than those who do not receive such

intervention.


CBNE instructional intervention will have

higher scores in their acceptance to follow CBNE during the COVID pandemic than those

who do not receive such intervention.

Materials & method

Research design: a quasi-experimental

research design was operated.


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Setting: This study was conducted at the Faculty of Nursing, Alexandria University in

Egypt. CBNE instructional intervention was

conducted at the College council venue (it was

prepared well for experimental group only for

four days). The control group was selected from

all nine scientific nursing departments in the

college, namely: Medical& Surgical Nursing,

Critical Care and Emergency Nursing, Pediatric Nursing, Obstetric and Gynecological Nursing,

Gerontological Nursing, Psychiatric and Mental

Health Nursing, Community Health Nursing,

Nursing Administration and Nursing Education

Departments.

Study subjects: involved nursing

acadenics who have a doctoral degree, and they

are involving in the planning of nursing

program’ and course’s spisification

development in the faculty (lecturers, assisstant

professors and professors).

The minimal sample size that was estimated

based on Epi info program is 76.

Therefore, conveniently the study sampling

recruitment reaches 84 nursing academics, as

follow:

Group A: A convenopei sample of 42

nursing academics who wpdp assigned as an

expreomental group because they regostered and attendpr the CBNE instructional

intervention after announcement in the

Nursing Faculty.

Group B: A convenopei sample of 42nursing

academics who assigned as a control group

and accepter to participate into the study and

not regostered or attend the CBNE

instructional intervention. Group B was

selected convenoently from all the nine

scientific nursing departments, by

proportionate random sampling approach from each department. The researchers

recruited the control group sample number

until it became approximately equal to the

experimental group.

Tools: a triple section evaluation sheet was developed by the researchers which included

three parts for data collection:

a. Part one: CBNE knowledge test: that was developed by the researchers after a

thorough review of the related literature,

(Dashash et al, 2020, Page 2020, Ramos-

Morcillo et al, 2020, Brownie et al, 2018,

Lucey 2018, National Authority for Quality

Assurance and Accreditation of Education

2017, Gravina 2017, Inter-professional

Education Collaborative 2016, Englander et

al, 2013) to determine nursing academics'

knowledge about CBNE. It comprised

eleven Multiple Choice Questions (MCQ)

about major and significant content of the

CBNE in terms of; major concepts,

components, stages, levels, principles and hazards or benefits of such system during

COVID pandemic. Those questions were

followed by three open ended questions

about; CBNE domains in the NARS 2017,

justifications about hazards or benefits of

implementing CBNE during COVID era.

Scoring for MCQs was dependent on the

right answer that took one and wrong one

that took zero. For open ended questions,

the scoring was dependent on the number of

nursing academics' responses for each open

ended question. Analysis and interpretation of the open question’ responses followed the

process of grouping of similar responses and

deriving a specific number of items for each

question.

b. Part two: CBNE planning skills rubric: that was developed by the researchers after a

thorough review of the related literature,

(Page 2020, Austin 2019, Lucey 2018,

Gravina 2017, Inter-professional Education

Collaborative 2016, Albanese et al, 2010) to

determine nursing academics' CBNE planning skills. It included six higher

planning skills, in terms of: developing

competencies statements for each domain in

NARS 2017, developing learning outcomes

for each competency, filling nursing

bachelor program specification template,

filling course specification template, and

filling program competencies\learning

outcomes\courses matrix, and mechanics,

grammar and understanding. Each planning

skill rated against four points rating scale; which is; poor = 1, inadequate= 2, adequate

= 3, and exemplary = 4. Six is the minimum

scoring which represents poor CBNE

planning skills performance. Above 6 to 12

is indicated inadequate CBNE planning skill

performance. In between 12 to 18 is showed

adequate CBNE planning skill performance.

From 18 to 24 is the maximum scoring

which represents excellent CBNE planning

skills performance.


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c. Part three: CBNE acceptance scale: It

was developed by the researchers based on a

thorough review of related literature

(Wallace et al, 2021, Dashash et al, 2020,

Page 2020, Austin 2019, Lucey 2018,

Gravina 2017, Inter-professional Education

Collaborative 2016, Morris et al, 2012,

Sangwan et al, 2012, Fieger 2012, Albanese

et al, 2010). The scale was designed to assess and measure nursing academics'

attitude, value and satisfaction toward using

the CBNE that represented their acceptance

to follow such oncoming system, during the

COVID crisis in their nursing faculty. This

scale included 30 statements; ten for the

attitude, ten for the value and ten for the

satisfaction. Each statement is rating against

five points rating scale; that are ranging

from strongly disagree= 1, to strongly agree

= 5. The total score is 150. Above 75

represents high level of acceptance for following CBNE among nursing academics.

Below 75 denotes their low level of

acceptance.

Additionally, Academic’s profile sheet is

attached.

The three parts of study tool were checked

for its face and content validity by five experts

in the fields of Medical & Surgical Nursing,

Psychiatric and Mental Health Nursing, Community Health Nursing, Nursing

Administration and Nursing Education

Departments, and accordingly, essential

modifications were done. Moreover, the three

parts of the study tool were statistically checked

for reliability as follows: part one and three

were tested by Cronbach Alpha Coefficient

Statistical Test for internal consistency for its

items that denoted = 0.74 to 0.77, and 0.68 to

0.73 respectively. Part two was tested by inter-

rater reliability by Cohen's Kappa Coefficient Statistical Test to check its scores consistency

when used by three different raters. This part

indicated K =0.69 in such reliability, with 95%

confidence interval.

Data collection procedure:

A pilot study was established on ten

nursing academics that were excluded from the

study sample, using the study tool with the

developed CBNE templates (program

specification, course specification and program

learning outcomes/courses matrix) that were

evaluated by part two of the study tool, and thus

significant changes were nirp. The current

study passed into four phases: pre-test,

planning, conduction and post-test:

Pre-test phase: both study groups received

and filled the study tool with the developed

CBNE templates (program specification,

course specification and program learning

outcomes/courses matrix) before conducting

the CBNE instructional intervention, with

the presence of the researchers to guide the

nursing academics in answering them. (for

control group, they filled the study tool on

individualized bases and for the experimental group, they received the study

tool, half an hour before the instructional

intervention and on group bases)

Planning phase: Based on ihp pre-test

phase and a thorough review of the related

literature, CBNE instructional intervention

was planned and developed including aim,

objectives, contents, active teaching

strategies (such as discussion, brain

storming, demonstration and presentation).

Pictures, illustrative PowerPoint, descriptive diagrams, templates of program, course

specifications, program and course matrix

and handouts were developed. The content

of the instructional intervention was

checked and reviewed for content validity

by a jury of three experts in nursing

education, and administration departments.

The jury scientifically investigated the

instructional intervention content and

decided if it includes typical elucidations

and interpretations with explanation about CBNE outlines for concepts, definitions,

features, rational, levels, development,

implementation, student’s assessment,

writing competency and learning outcomes

statements, program and course

specification, policies and barriers, during

COVID crisis. Additionally, the jury ensures

the content details representation to the

evidences and theories or literature that

related CBNE and NARS 2017.

Arrangements and announcement about the

CBNE instructional intervention were established with student’s affair department.


130

Registration and venue preparation were

prepared by the researchers and the quality

unit and academic affairs.

Conduction phase: the developed CBNE

instructional intervention was implemented

with the experimental group only who

received theoretical and application parts

through four days and 16 hours (4 for each

day). Examples, explanations, questions and justifications were delivered during the

CBNE instructional intervention using the

flip chart, presentation, and discussion or

demonstrations. Each nursing academic in

the experimental group received two

teaching sessions in one day with half an

hour break, on two sequential days.

Post-test phase: the study tool with the

developed CBNE templates (program

specification, course specification and

program learning outcomes/courses matrix) were used again with both study groups.

The scores of the three parts of the study

tool before and after CBNE instructional

intervention for both study groups were

calculated, compared, and then, the

difference between both groups ’scores was

estimated. Thus, the effect of the developed

CBNE intervention during the pandemic era

with nursing academics was determined.

Part one and part three of the study tool

were filled by self-reporting methodology,

while, part two was filled by the researchers after observing and evaluating the CBNE

planning skills of nursing academics when

filling the CBNE templates, (program

specification, course specification and

program learning outcomes/courses matrix).

Ethical considerations: Written agreements

were obtained from the ethical committee,

for conduction of the study. Also, written

informed consents were taken from the

nursing academics in the study sample after full description of the purpose and the

method of the study. The nursing academics

were ascertained that they participated in the

study with their full voluntary decision.

Additionally, they were reassured that all

their answers were used with a confidential

approach. Also, anonymity was ascertained,

by avoiding the participants putioei their

names on the study tool. Moreover, the

participants were ensured that they can

withdraw from the study at any time of the

study phases.

Data Analysis:

The collected data was fed to the

computer, coded, investigated and arranged and presented. Statistical Packages for the Social

Sciences (SPSS) version 20.0 for Windows

(Office 2010) were employed for calculating

and revealed the study findings. Number,

percentage, mean and standard deviation were

used for descriptive data. Chi-square was used

for test of significance with P values.

Results:

Table I clarifies that approximately one

third of both groups (28.57%, 30.95 %) were in between 45, and 55yearsold and almost eiih io

ihpn (90.48%, 95.21%) were females. It is

obvious that all college departments were

representative in both study groups, just about

equally. Nearly one third of both groups, for

group A (35.71%, 30.95 %) and for group B

(28.57%, 26.19%); are lecturers and assistant

professors, respectively. Almost both groups

did not attend any CBNE educational sessions

during COVID crisis and likewise, the majority

of both did not participate in any CBNE

committee in the faculty. Generally, there was no apparent statistically significant difference

among both study groups as regards their

profile, and the level of significance < 0.05.

Table II illustrates a hoihpd

improvement in the experimental group 's

knowledge about CBNE before and after the

instructional intervention than the control

group, regarding all knowledge tests

.Concerning, identifying the CBNE’ major

concepts among group A before conducting the

instructional intervention, minimal percentages (2.38%, 4.76%, 14.29%, 7.14%, and 23.81) of

them mentioned those concepts correctly. But,

after conducting the instructional intervention,

academics in group A approved an apparent

improvement in understanding and reporting

those major concepts, so, their percentages

became high (78.57%, 71.43%, 95.24%,

78.57%, and 97.62). tui, group B, did not show

any improvement in identification of those

CBNE’ major concepts before, and after

conducting the instructional intervention,

respectively.


131

In relation to ihp CBNE components,

stages and levels of development, few

percentages of group A (11.9%, 16.67%, and

2.38 %) reported right answers, before

conducting the intervention, however, after

conducting it, great percentages of them

(95.24%, 90.48%, 78.57%) documented right

answers. On the other hand, group B, did not

indicate any progress in awareness of those CBNE items before and after conducting the

instructional intervention.

Pertaining to CBNE principles and

domains, the majority of both groups (59.52%,

83.33% for group A and 71.43%, 73.81% for

group B) provided wrong answers before

conducting the instructional intervention.

However, after conducting the instructional

intervention, those percentages among group A

became very minimal (4.76%, 2.38%), while,

in-between group B, those percentages

approximately dpnioeprthe same (66.67%, 78.57%). This result denoted that almost all of

experimental group didn’t have any wrong

answers about the CBNE principles and

domains but the control group still, has wrong

answers about such items.

For subjects' awareness io ihp CBNE

difficulties among academics and students,

about two thirds of both groups A & B

(71.43%, 61.90%), before, conducting the

instructional intervention reported that CBNE has no difficulties. But, after conducting the

instructional intervention, these percentages

became (95.24%, 66.67%) in favor of the

experimental group who approve their refusal

that CBNE has any difficulties for academics or

students.

The study groups mentioned some CBNE

difficulties according to their point of views; in

terms of: Exposing nursing students to COVID

infection, they are Exhaustion due to

continuous physical presence, Difficulty in teaching and assessment, Provoking stress, fear

and anxiety and wasting money and effort.

With reference to the subjects' awareness

if CBNE benefits, for academics and students,

the majority of both groups A & B (78.57%,

71.43%), before, conducting the instructional

intervention, reported that CBNE is beneficial.

But, after conducting the instructional

intervention, these percentages became

(90.48%, 69.05%) in favor of experimental

group who admire their complete agreement

that CBNE is beneficial for academics and

students.

The groups mentioned some CBNE

benefits according to their points of view; in

terms of Enhancing students nursing skills,

Consider a preparation to confront such i crisis,

Meet work needs without errors, Maintaining

high quality of nursing practice, Improve nursing educational services, and Saving effort

and time

Generally, it was observed that there was a

statistically significant difference between both

groups particularly, after conducting the CBNE

instructional intervention for almost all items in

the knowledge test and P = 0.000. The CBNE

instructional intervention showed a significant

and effective influence in improving group A’

CBNE knowledge.

Table III denotes that both study groups

have inadequate CBNE’s planning skills scores, before the instructional intervention. But, after

the instructional intervention, the experimental

group showed an apparent progress in all

CBNE’s planning skill in all rubric items,

while, the control group showed no

improvement. For example, regarding,

developing competencies’ statements according

to NARS 2017, it was observed that there was

significant percentages of group A (28.57%,

50%) ihii have an excellent and accepted

skill scores, after the CBNE instructional intervention which were poor and inadequate

before the CBNE instructional intervention. On

the other hand, and with a comparison with

group B, they have poor and inadequate skill

scores before and after conduction of CBNE

instructional intervention, unlike group A.

a. Perceived attitude toward CBNE

As regards table IV, it reveals the CBNE’s

attitude scores among experimental and control

groups during COVID era. According to the

scale’s mean scoring, above 2.5 mean scores indicated CBNE positive attitude and below 2.5

mean scores denoted a CBNE negative attitude

during COVID era. Therefore, it was clear that

both study groups have CBNE negative attitude

before conduction of CBNE instructional

intervention during COVID era. While, after

conduction of CBNE instructional intervention

during COVID circumstances, group A mean

scores were improved and became above 2.5


132

for all subscale items, but group B has no

improvement and continued approximately the

same.

Perceived CBNE value

Concerning table V, oi clarifies the

CBNE’s value scores among experimental and

control groups during COVID pandemic.

According to the scale’s mean scoring, above

2.5 mean scores indicated high CBNE value perception and below 2.5 mean scores denoted

low CBNE value perception during COVID era.

Therefore, it was obvious that both study

groups have low perception of CBNE value

before conduction of CBNE instructional

intervention during COVID era. While, after


during COVID era, group A mean scores were

improved and became above 2.5 for all subscale

items, but group B has no improvement and

sustained almost the same.

Perceived satisfaction toward CBNE Table VI elucidates the CBNE’s

satisfaction score levels among experimental

and control groups during COVID pandemic.

Inconsistency, with the scale’ scoring, above

2.5 mean scores show pr high CBNE

satisfaction, and below 2.5 mean scores

indicated low satisfaction level regarding

CBNE during COVID era. Consequently, it was

understandable that both study groups have low

CBNE satisfaction level before conduction of

CBNE instructional intervention during COVID era. While, after conduction of CBNE

instructional intervention during COVID era,

group A mean scores were improved and

became above 2.5 for all subscale items, but

group B has no improvement and continued

approximately the same.

Figure 1 shows knowledge, planning

skills, and acceptance scores about CBNE

among the control group before and after


during COVID pandemic as presented by

score’s percentages averages. They have

limited scores before the intervention and after

intervention; their scores approximately still the

same. Figure 2 clarifies knowledge, planning

skills, and acceptance scores about CBNE

among the experimental group before and after


during COVID pandemic as presented by

score’s percentages averages. The improvement

is obviously observed which approves the

effectiveness of the CBNE instructional

intervention among academics at knowledge,

skills and attitude levels.


133

Table I: Nursing academics profile (N=84).

Nursing academic’s profile Group A (N=42) Group B (N=42) Test of Significant

(X2) No. % No. %

Age

25 < 35

35 < 45

45 < 55

55 < 65

Above 65

9

6

12

6

9

21.42

14.28

28.57

14.28

21.43

8

8

13

7

6

19.05

19.05

30.95

16.67

14.28

X2= 1.0615

P= 0.9003

: Sex

Male

Female

4

38

9.52

90.48

2

40

4.76

95.21

X2= 0.7179

P= 0.3968

Department:

Community Health Nursing

Critical Care &Emergency

Nursing

Gerontological Nursing

Medical & Surgical Nursing

Nursing Administration

Nursing Education

Obstetric and Gynecological

Nursing

Psychiatric and Mental Health

Nursing

Pediatric Nursing

3

6

5

5

3

5

4

5

6

7.14

14.28

11.90

11.90

7.14

11.90

9.52

11.90

14.3

5

5

5

4

5

4

4

5

5

11.90

11.90

11.90

9.52

11.90

9.52

9.52

11.90

11.90

X2= 1.2573

P= 0.996

Academic position:

Lecturer

Assistant professor

Professor

Full time assistant professor

Full time professor

15

13

5

3

6

35.71

30.95

11.90

7.14

14.29

12

11

7

5

7

28.57

26.19

16.67

11.90

16.67

X2= 1.4103

P= 0.8424

Previously attend CBNE session

during COVID crisis:

Yes

No

7

35

16.67

83.33

5

37

11.90

88.09

X2= 0.3889

P= 0.5329

in CBNE committee Participate

in the faculty:

Yes

No

2

40

4.76

95.21

3

39

7.14

92.86

X2= 0.2127

P= 0.6447

X2 = Chi square test, P: level of significance< 0.05* = p 0.05 ** = p 0.01 *** = p 0.001


134

Table II: CBNE’s knowledge among experimental and control groups, before and after the instructional intervention, as presented by number, and

percentage. (N=84)

CBNE Knowledge items

Group A (N=42) Group B (N=42)

Test of Significant(X2)P value Before After Before After

No. % No. % No % No. %

Major CBNE concepts

Competence

Competency

Performance/Learning Outcome

Authentic assessment

CBNE

1

2

6

3

10

2.38

4.76

14.29

7.14

23.81

33

30

40

33

41

78.57

71.43

95.24

78.57

97.62

2

3

4

2

8

4.76

7.14

9.52

4.76

19.05

3

4

4

3

11

7.14

9.52

9.52

7.14

26.19

X2a = 7.378 P= 0.122

X2b = 0.202 P=0.995

X2c = 1.142 P=0.888

X2d = 1.931 P=0.748

Components of Competency based Education

Knowledge, Skills, Attitudes, and personal

characteristics 5

37

11.9

88.1

40

2

95.24

4.76

7

35

16.67

83.33

5

37

11.90

88.09

X2a = 58.63 P= 0.000*

X2b = 0.389 P=0.533

X2c =0.389 P=0.533

X2d =58.63 P=0.000* Wrong response

Stages of competency development

1-Unconscious incompetence, 2- Conscious

incompetence, 3- Conscious competence, 4-

Unconscious competence

7

35

16.67

83.33

38

4

90.48

9.52

3

39

7.14

92.86

5

37

11.90

88.09

X2a =45.99 P= 0.000*

X2b = 0.553 P=0.457

X2c = 1.816 P=0.177

X2d = 51.87 P=0.000* Wrong response

Levels of competency development

1-Novice, 2-Competent, 3-Experienced/

Advanced, 4- Master/Expert 1

41

2.38

97.62

33

9

78.57

21.43

4

38

9.52

90.48

3

39

7.14

92.86

X2a = 50.59P= 0.000*

X2b = 0.156 P=0.693

X2c = 1.914 P=0.167

X2d = 43.75 P=0.000* Wrong response

Principles of CBNE ▲

1. Offers learning flexibility

2. Focusse on students' achievement

3. Allows mastering of nursing skills

4. Permits learning with student’s pace

5. Enhances student’s engagement

6. Emphasizes on reality and job work

7. Improve the educational services’ quality

8. Use of authentic assessment

12

9

17

3

5

3

11

4

25

28.57

21.43

40.48

7.14

11.90

7.14

26.19

9.52

59.52

35

32

40

38

36

30

33

28

2

83.33

76.19

95.24

90.48

85.71

71.43

78.57

66.67

4.76

11

4

11

5

5

9

8

3

30

26.19

9.52

26.19

11.90

11.90

21.43

19.05

7.14

71.43

14

6

13

7

5

13

7

10

28

33.33

14.28

30.95

16.67

11.90

30.95

16.67

23.81

66.67

X2a =85.31 P= 0.000*

X2b = 4.398 P=0.819

X2c =7.774 P=0.456

X2d = 78.63 P=0.000*

Wrong answer

Listing the domains of competencies according to NAES 2017 ▲

Domain 1: Professional and Ethical Practice

Domain 2: Holistic Patient-Centered Care

Domain 3: Managing People, Work

Environment, and Quality

Domain 4: Informatics and Technology

Domain 5: Inter-professional Communication

5

5

2

7

2

35

11.90

11.90

4.76

16.67

4.76

83.33

41

36

33

34

32

1

97.62

85.71

78.57

80.95

76.19

2.38

3

5

3

11

4

31

7.14

11.90

7.14

26.19

9.52

73.81

5

4

6

9

6

33

11.90

9.52

14.28

21.43

14.28

78.57

X2a =126.79 P=0.000*

X2b =1.979 P=0.852

X2c = 2.489 P=0.778

X2d = 104.29 P=0.000*

Wrong response

During COVID pandemic, the implementation of CBNE is difficulties for nursing academics &students?


135

Yes

No 12

30

28.57

71.43

2

40

4.76

95.24

16

26

38.10

61.90

14

28

33.33

66.67

X2a = 8.571 P= 0.003*

X2b = 0.207 P=0.649

X2c = 0.857 P=0.354

X2d = 11.12 P=0.001*

The hazards when implementing CBNE during COVID crisis ▲

1. Exposing nursing students to COVID infection

2. Exhaustion due to physical presence

3. Difficulty in teaching and assessment

4. Provoking stress, fear and anxiety

5. Wasting money and effort

6. No response

5

4

4

3

2

3

11.90

9.52

9.52

7.14

4.76

7.14

1

0

1

0

0

0

2.38

0.00

2.38

0.00

0.00

0.00

6

5

8

6

7

4

4.28

11.90

19.05

14.28

16.67

9.52

7

6

5

7

7

6

16.67

14.28

11.90

16.67

16.67

14.28

X2a = 2.427 P= 0.787

X2b =1.284 P=0.937

X2c =1.621 P=0.898

X2d = 4.035 P=0.544

During COVID pandemic, the implementation of CBNE is beneficial for nursing academics &students?

Yes

No 33

9

78.57

21.43

38

4

90.48

9.52

30

12

71.43

28.57

29

11

69.05

26.19

X2a = 2.275 P= 0.132

X2b =0.012 P=0.914

X2c = 0.571 P=0.449

X2d =4.429 P=0.035

The benefits when implementing CBNE during COVID crisis ▲ 7. Enhancing student’s nursing skills

8. Consider a preparation to confront such crisis

9. Meet work needs without errors

10. Maintaining high quality of nursing practice

11. Improve nursing educational services

12. Saving effort and time

13. No response

3

2

2

2

2

3

4

7.14

4.76

4.76

4.76

4.76

7.14

9.52

18

9

22

26

17

12

2

42.86

21.43

52.38

61.90

40.48

28.57

4.76

4

3

3

2

2

1

6

9.52

7.14

7.14

4.76

4.76

2.38

14.28

3

3

4

4

4

2

4

7.14

7.14

9.52

9.52

9.52

4.76

9.52

X2a = 15.844 P= 0.015*

X2b = 2.162 P=0.904

X2c = 1.722 P=0.943

X2d = 10.70 P=0.098

X2 = Chi square test, P: level of significance < 0.05 ▲Some participants reported more than one response * = p 0.05 ** = p 0.01 *** = p 0.001

X2acomparison between study group pre and post X2b comparison between control group pre and post

X2c comparison between study group and control group pre X2d comparison between study group and control group post


136

Table III: CBNE’s planning skills among experimental and control groups, before and after the

instructional intervention, as dppresented by number and percentages. . (N=84)

CBNE planning skills RUBRIC Group A (N=42) Group B (N=42)

Before CBNE

instruction

After CBNE

instruction

Before

CBNE

instruction

After CBNE

instruction

No % No % No % No %

1- Developing competencies statements according to

NARS 2017

Exemplary (Excellent) (96-120)

Adequate (Accepted) (66-95)

Inadequate (Below standard) (36-65)

Poor (6-35)

3

4

15

20

7.14

9.52

35.71

47.62

12

21

8

1

28.57

50

19.05

2.38

5

6

22

9

11.90

14.28

52.38

21.43

3

10

19

10

7.14

21.81

45.24

21.81

2-Developing LOs for matching each competency




Poor (6-35)

1

5

22

14

2.38

11.90

52.38

33.33

10

25

7

0

21.81

59.52

16.66

00.0

3

3

6

30

7.14

7.14

14.28

71.43

5

3

12

22

11.90

7.14

28.57

52.38

3-Filling program specification template




Poor (6-35)

4

4

4

34

9.52

9.52

9.52

80.95

11

29

2

0

26.19

69.05

4.76

00.0

5

6

4

27

11.90

14.28

9.52

64.28

4

4

10

24

9.52

9.52

21.81

57.14

4-Filling course specification template




Poor (6-35)

5

2

16

19

11.90

4.76

38.1

45.24

15

22

3

2

35.71

52.38

7.14

4.76

6

6

17

13

14.28

14.28

40.48

30.95

4

3

20

15

9.52

7.14

47.62

35.71

5- Filling program competencies\ learning

outcomes\courses matrix




Poor (6-35)

2

4

20

16

4.76

9.52

47.62

38.1

12

26

3

1

28.57

61.91

7.14

2.38

3

4

24

11

7.14

9.52

57.14

26.19

2

2

28

10

4.76

4.76

66.66

21.81

6-Mechanics, grammar and understanding




Poor (6-35)

10

12

20

0

21.81

28.57

47.61

0.00

22

16

4

0

52.38

38.1

9.52

00.0

13

17

10

2

30.95

40.48

21.81

4.76

10

15

15

2

21.81

35.71

35.71

4.76

The following section represents the study subjects' acceptance scores toward implementing CBNE

in the nursing college, before and after conduction of the instructional intervention during the

COVID pandemic, in terms of their perceived attitude, value and satisfaction toward CBNE.


137

Table IV: CBNE’s attitude among experimental and control groups, before and after the instructional intervention, during the COVID pandemic, as dppresented by mean and standard deviation (N=84)

Perceived CBNE attitude items


Before CBNE

instruction

After CBNE

instruction

Before CBNE

instruction

After CBNE

instruction

Mean SD Mean SD Mean SD Mean SD

1. I feel that CBNE is required in the nursing

faculty for equipping students to fight

healthcare crises.

2.07 0.58 4.32 1.26 1.56 0.58 1.78 1.65

2. I perceive that CBNE system allows teachers

for creating, applying & sharing content

materials easily in the current risk era.

1.11 1.78 4.61 1.09 2.11 1.11 2.22 0.67

3. I should have enough CBNE training on

planning & application, in the current risk time. 1.62 0.58 4.11 1.11 1.98 1.08 1.71 1.54

4. I should be CBNE literate to have better future

management with any healthcare crises. 1.73 1.49 4.92 0.78 1.95 0.89 2.02 1.18

5. I appreciate the use of CBNE in the nursing

faculty in the present COVID time. 1.44 0.48 4.23 1.49 2.13 1.18 2.33 0.97

6. I feel that CBNE allows collaborative, flexible

academic work during risk times. 1.67 1.39 4.25 1.01 2.03 1.89 2.11 1.44

7. CBNE will be interesting for students and

academics in online, classrooms or in clinical

and practical areas during such risk time.

1.78 1.33 4.55 0.49 1.54 1.95 1.88 1.54

8. Both students & academics will be more active,

engaged, and productive with CBNE to face

such healthcare crises

2.00 0.88 4.12 1.26 1.34 0.56 1.87 0.26

9. I feel that I will follow CBNE easily in the

current COVID risk time. 1.74 1.35 4.01 1.98 1.55 1.22 2.01 1.53

10. I will be initiative to attend CBNE training

workshops in the current risk era. 2.11 0.77 4.05 1.51 1.77 0.49 2.44 0.74

Total 1,73 1.06 4.32 1.19 2.16 1.79 2.04 1.15

Table V: CBNE’s value among experimental and control groups, before and after the instructional

intervention, during COVID pandemic, as presented by mean and standard deviation (N=84)

Perceived CBNE value items


Before CBNE

instruction

After CBNE

instruction

Before CBNE

instruction

After CBNE

instruction


11. CBNE will approve efficiency in student’s &

academic’s achievement progress in work

situation mainly in risk time as nowadays.

2.11 1.87 4.11 1.34 1.33 0.78 1.67 0.89

12. Nursing students will have experts skills to

achieve high quality of nursing care and fight

COVID complications in the society

2.12 0.78 4.32 0.69 1.87 1.43 2.01 1.43

13. CBNE will approve improvement in nursing

academic’s teaching performance, mainly with

the current risk circumstances

2.27 0.66 3.77 1.44 1.56 1.23 1.98 0.84

14. CBNE will enhance the faculty educational

quality and improve the value of it in the eyes of

the community

1.89 1.15 4.18 1.13 1.23 1.45 1.77 1.74

15. Nursing students will use their ability to

master skills at their own pace that allow them

limit the hazards of COVID risks.

1.23 0.55 4.08 1.66 1.56 1.67 2.45 1.54

16. Academic’s & student’s learning needs

differences will be met with CBNE in such

critical situation

1.77 1.34 4.42 1.25 1.45 1.23 1.91 0.78

17. With CBNE, academics &students will be

experts to save time, effort and cost 1.89 0.56 4.25 1.23 2.04 1.56 2.55 0.94

18. CBNE, will fit work requirements and

enhance it without errors which is a necessary in

the current risk time

2.34 0.79 3.78 0.96 1.55 0.78 1.89 1.43


138

Perceived CBNE value items


Before CBNE

instruction

After CBNE

instruction

Before CBNE

instruction

After CBNE

instruction


19. In CBNE, nursing academics will use many

teaching methodology, assessment

authenticity which strengthen their

qualifications

1.74 1.56 3.66 1.11 1.45 0.73 2.51 1.11

20. CBNE will add positive effects ii the

reputation of nursing field. 1.95 0.86 4.34 0.78 2.11 0.47 2.32 0.89

Total 1.93 1.01 4.09 1.16 1.62 1.13 2.11 1.16

Table VI: CBNE’s satisfaction among experimental and control groups, before and after the

instructional intervention, during COVID pandemic, as presented by mean and standard

deviation. (N=84)

Perceived CBNE’s satisfaction level


Before

CBNE

instruction

After CBNE

instruction

Before

CBNE

instruction

After CBNE

instruction


21. I appreciate that CBNE can be used easily and

with flexibility with distance precautions 1.31 0.69 3.67 0.94 1.11 0.34 1.77 0.56

22. I feel that with CBNE nursing academics and

students' need will be recognized & understood,

even in current crisis.

1.67 1.08 4.16 1.89 1.45 1.11 1.22 0.44

23. I appreciate that in CBNE, we will use blended

teaching & online platforms which will fit

COVID precautions

1.69 1.16 3.88 1.11 1.93 0.83 2.18 0.68

24. I anticipate that CBNE will upgrade academics

potentials which idp required in crises era 2.17 1.67 4.56 1.34 1.22 0.75 1.45 1.22

25. I have a confidence in authentic assessment ier

in CBNE ensures competency achievement that

we need oe crisis situations

1.90 0.78 4.78 0.86 1.26 1.14 2.12 1.34

26. I appreciate that in CBNE, teachers can identify

strengths & defects of teaching, in such crisis

era

1.45 1.11 3.67 1.11 1.85 1.44 1.67 0.89

27. I appreciate that in CBNE, nursing students will

attain enough chances for training, even with

COVID restrictions.

1.67 1.11 4.22 1.21 1.67 1.56 1.45 1.33

28. CBNE develop students' problem-solving skills

that help them deal with any crisis. 2.11 1.45 3.89 0.89 1.45 0.72 1.34 1.11

29. CBNE helps students to be self-dependent,

clinical judgers, even with any crisis. 2.09 0.89 4.44 1.54 2.44 1.07 1.55 1.45

30. CBNE improves students' soft & hard skills that

permitted them to manage efficiently at risks. 1.56 1.21 3.78 1.45 2.12 0.67 2.11 0.78

Total 1.76 1.16 4.11 1.23 1.65 0.96 1.69 0.98


139

Figure 1: Illustrates knowledge, planning skills, and acceptance scores about CBNE among the control group before and after conduction of CBNE instructional intervention during COVID pandemic as presented by score’s percentages averages, (N=84)

Figure 2: Illustrates knowledge, planning skills, and acceptance scores about CBNE among the experimental group before and after conduction of CBNE instructional intervention during COVID pandemic as presented by score’s percentages averages, (N=84)

Discussion

Nurses are often the specialists for

supporting and providing competent healthcare

when necessary, advising, helping, saving sick

or healthy people at any difficult health

problem. They are attending at critical

moments, and calming once patients feel

worries or fear. Nurses are the fundamental and

crucial professionals in healthcare system. In

Egypt, there are many challenges faced nurses

in their work; like: massive spreading of

infectious (COVID and others), appearance of

several health problems for women, children,

the elderly, and adults. Additionally, intense

staff shortage, practice’ errors, poor salaries,

overloading work, lacking of cognitive and behavioral skills and competition to approve

0

10

20

30

40

50

60

70

80

90

Knowledgescores

Planning skillsscores

Acceptancescores

14.3

27.4

15.7 18.5 25.9

20.6

Before

After

0

10

20

30

40

50

60

70

80

90

Knowledgescores

Planningskills scores

Acceptancescores

13.9 25.3 19.4

77.4 81.7

87.3

Before

After


140

accepted quality and image of nursing serveries

nationally and internationally, considered a

great challenges. Therefore, upgrading of

nursing education has become urgent. Nursing

student’s preparation becomes necessitate and

national need. (Brownie et al., 2018, Ramos et

al., 2019, Watson, et al., 2002, El Tawil 2021,

Wu and Martin, 2019)

There are many nursing education programs in Egypt affiliated to two isolated

governmental ministries: 1- ehp Ministry of

Health and Population (MoHP) covers

secondary nursing schools and technical and

associate nursing institutes which awarded a

diploma and associate certificates, and 2-the

Ministry of Higher Education (MoHE) which

covers the graduate and postgraduate levels of

nursing programs that provided bachelors and

post-graduation certificates. Since 2017, the

government has a vision to implement CBE

allover Egyptian universities and in all specialties. Egyptian government stressed on

the importance of implementing CBE in

nursing and medical education as vital health

specialties. (National Authority for Quality

Assurance and Accreditation of

Education2017, Brownie et al, 2018, Ma et al.,

2012, Technical Institutes Directorate 2017)

Particularly, CBNE has created growing

thoughtfulness, attention, and argument among

healthcare academics and professionals since

the beginning of the current decade, particularly in the developed countries. (Frank

et al. 2010, Blömeke et al, 2013, Brownie et al,

2018, Salman et al, 2020) CBNE system

becomes the necessitated educational approach

in the bachelor nursing program as strong

means to close the gap between theory and

practice as a foundation for professional

practice. (Boyle et al, 2016, Fukada, 2018,

Garneau et al, 2017, Frank et al. 2010)

Egyptian academic community has a great

struggle and competition to prepare their graduates with such approach which allows

efficiency, expertise, and proficiency in the

clinical practice. Hence, to follow such crucial

system, preparation of nursing academics by fit

training intervention is essential.

According to the revealed results in the

current study, after providing the CBNE

instructional intervention, group A approved

apparent improvement in acquiring CBNE

related knowledge than group B whom have no

observed progress in such variable. Group A

reported such progress regarding CBNE

concepts, components, stages, levels,

principles, and identifying NARS 2017’

domains of competencies. Therefore, and

matching with the first research hypothesis,

there is significant statistical difference between experimental and control groups as

regards gaining the CBNE knowledge in favor

of experimental group, after conducting of

CBNE instructional intervention. The CBNE

approve clear effectiveness in changing

academic’s knowledge that will have a

wrathful reflection on their achievement in the

future. Such educational programs required for

the academics if there is any curricular change.

Ahmed and Sayed in 2021conducted a study in

Assuit, Egypt, and reported that competency

based education is necessitated to build educator’s understanding toward new

knowledge, concepts and awareness with the

change agent introduced in the collage. Also,

the authors added that the educators need

numerous formats of training, containing

workshops, seminars, visits, case studies,

coaching, and mentoring. (Ahmed and Sayed in

2021) supporting to this view, Kang and

Pavlova in 2019discusses that to develop

academic work identity, theories, models,

principles, processes, and concepts of the related content of training, they should acquire

deep, clear, accurate and comprehensive details

about any induced subject or reform.

Academic’s education or instruction trials must

be included all review and backgrounds which

can improve trainee’s comprehension and then,

academic motivation and commitment will take

place. In the same line, and additionally, Zhang

et al., in 2017 illustrated that teachers and

academics need wide range of knowledge and

understanding with the training content as a grass root for professional development which

enable them integrate such knowledge into

practice and easily reaching the organization’

target. (Kang and Pavlova 2019, Zhang

et al., 2017) The academics should use

theoretical part with the practical part, together,

thus, knowledge base is necessary to achieve

the application into reality.

https://onlinelibrary.wiley.com/action/doSearch?ContribAuthorStored=Ahmed%2C+Adel

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141

The major goal of CBNE is to translate all

content of teaching into doing. Similarly,

CBNE, particularly in a crucial field like

nursing, needs knowledge capitalizing, and

integrate acquired knowledge into learning

experiences building. Likewise, CBNE

flexibility should be understood well by

nursing academics through recognizing that

CBNE methodology obligates the students to be accountable for achieving performance

outcomes of competencies with no certain time

or certain place for such achievement. CBNE

has a wide range of concepts, principles,

features and components that should be

clarified with academics for allowing them

having effective planning and implementation.

(Zineb et al, 2017, Ahmed and Sayed, 2021,

Brownie et al. 2018) Therefore, any

educational program for academics should

provide great considerations for the bulk of

knowledge which is the fundamental ground for any training instruction.

Moreover, the CBNE instructional

program showed positive effects on subject’s

awareness about the benefits and difficulties of CBNE. Before conducting the intervention

both groups reported some CBNE benefits and

difficulties, but after the intervention, the most

of experimental group only, mentioned the

benefits without difficulties. It can be due to

their understanding of CBNE components and

how they can manage any difficulty easily.

Similarly to these views, Ahmed and Sayed in

2020 discussed that professional educators have to fit lot of professional potentialities in

their teaching career which allow them to

assess and manage any sufferings or problems.

(Ahmed and Sayed 2020, Ahmed and Sayed

2021)CBNE have many benefits that upgrade

the abilities of teachers and students, and if

there are any limitations, it can be due to

organization, fund, training, and timing or

polices, and limitations are not related to the

system itself.

Contradictory to the previous results, Friedler, in 2018 and Guo, &Qiu, in 2019,

Ahmed and Sayed in 2021, and Nyoni& Botma

in 2019 found that the CBE training program

has many obstacles and misunderstanding may

hinder the effectiveness of the CBE

implementation. Those obstacles can be

regarding the compliance to integrate

knowledge with application, restrictive rules,

regulation and policies, staff resistance, rigid

organizational culture and language difficulties,

limited economic preparations and

infrastructure presence and environmental

aspects. The didactic concepts of CBE requires

action and interaction instructional trials for

establishing the target of competence through

people participation to close the gap between theory and practice in a vital field like

healthcare and nursing practice. (Friedler,

2018, Guo, &Qiu, 2019, Ahmed and Sayed

2021, Nyoni& Botma in 2019) CBNE has great

benefits and influences in the colleges of

applied science because it allows joining the

subjects with the needs of professional

standards and work market that enforce the

nations for educational, political, economic,

and reproduction advances.

With referring to the finding in the current

study and after providing the CBNE instructional intervention, group A showed

apparent improvement than group B in

executing the CBNE planning skills in terms

of: Developing competencies statements

according to NARS 2017, Developing LOs for

matching each competency, Filling program

specification template, Filling course

specification template, and Filling program

competencies\ learning outcomes\ courses

matrix, plus their mechanics, grammar and

understanding skills were better. Group B has no noticed improvement in such skills.

Consequently, and corresponding with the

second research hypothesis, there is significant

statistical difference between experimental and

control groups as regards performing the

CBNE planning skills in favor of experimental

group. It is clear that the planning phase is the

huge phase in conduction any educational

projects. In CBNE, the planning phase

includes; planning for planning, planning for

implementation and planning for evaluation that are clear in its program and course

specifications or curricular matrix. Parallel to

such result, Zineb et al, in 2017discussed that

CBE curriculum is established and planned

using many different teachers’ skills. CBE

requires a comprehensive reform of practical or

clinical training systems and processes in the

faculty for staff and students plus the

environment at all. Such reform is clearly



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142

noticed and followed through accurate and

valid planning process. Likewise, in healthcare

and nursing fields, Wuet al, in 2019,

Sistermans in 2020 and Ahmed& Sayed in

2021detected that the teachers should be have

the basic planning skills that enable them to

plan suitable and feasible curricula. They have

to be responsible for demonstrating the skills in

writing the competencies and its learning outcomes. Flexibility and objectivity or

authenticity of the CBE should be noticed in

the curricular plan through the teaching

methodology, assessment tools and time table.

Representation of subjects for each competency

should be apparent in the curricular matrix.

Accordingly, CBE planning skills have to be

acquired by the teachers through effective and

comprehensive training. (Wu et al, 2019,

Sistermans 2020, Ahmed& Sayed 2021) each

competency should be settled with its learning

outcomes, teaching strategies, and assessment\ evaluation tools. Similarly, for each

competency the academics should plan for its

concepts, learning activities, clinical or

practical skills and put descriptions if needed.

Dissimilar to the previous finding, there

are many references explained many obstacles

and challenges that observed during the

planning for CBNE, particularly among

nursing academics and in nursing schools.

Bates in 2020, Bohain, and Hofman, in 2014,

Englander et al, in 2013, Frank et al, in 2010, Fukada in 2018, Pijl-Zieber et al, in 2013,

Salman et al, in 2020, and Watson et al, in

2002, mentioned that there are some

challenging and difficult aspects in the

planning for application of CBNE. One of the

areas that include the major troubles is

planning for assessment and evaluation in

which there is a serious lacking of instruments

that are valid, objective, and reliable for

competency measurement. Another aspect is

planning for competency courses quality assurance that entails some problems to

determine the criteria for operationalizing the

competencies and its LOs with limited models

or benchmarking examples. Additionally, some

challenges are raised when conductingng

curriculum planning with insufficient clear data

and vague terms of competency

implementation and its requirements in the

clinical settings, which could be unclear in

course specification. Furthermore, some

troubles appear in tailoring the teaching

methodology with fit teachers and various

learning styles of the nursing students. In

addition, there is an observable lacking of

CBNE studies about planning and evaluation

that may be a great source for academics

guidance and support. These planning skills

problems are provoking confusion and exhaustion among nursing academics. Also, in

the area of instructional planning for CBNE

teaching strategies, there is a challenge to plan

and tailor all college services to enhance

nursing student’s full independency in learning

competencies. (Bates 2020, Bohain, and

Hofman, 2014, Englander et al, 2013, Frank et

al, 2010, Fukada 2018, Pijl-Zieber et al, 2013,

Salman et al, 2020, and Watson et al, 2002)

Nursing is a vital disciple and needs close

supervision and support CBNE planning that

will be a huge beneficial shifting for nursing education advancement.

As regard the last finding in the current

study, and after conducting the CBNE

instructional intervention, group A gain high

scores and has apparent progress than group B

in CBNE acceptance scores during COVID

pandemic, in terms of: attitude, value and

satisfaction about the oncoming CBNE system

in the nursing collage. Group B has no noticed

improvement in such scores. Thus, and

matching with the third research hypothesis, there is significant statistical difference

between experimental and control groups as

regards CBNE acceptance scores during

COVID pandemic in favor of experimental

group. Academics in both groups were having

low scores in CBNE acceptance (attitude, value

and satisfaction), during COVID pandemic

before the instructional intervention. But, after

the intervention, the improvement was clear

with the experimental group only which

reflected the great role of CBNE instructional intervention and to which extend the awareness

and understanding of CBNE system may affect

positively to change ones’ attitude, value and

satisfaction, even during healthcare crises.

Nursing academics’ CBNE acceptance has a

major importance to help them in oncoming

smoothly implementing and following such

system successfully. Staff feelings may be the

most crucial domain to be changed and will


143

support staff compliance and adherence to

CBNE requirements during risk situation. In

Egypt, because, COVID crisis is coming

parallel in the same time with CBNE

preparation and planning in all Egyptian

colleges, some nursing educators may have

some fear about assuming the clinical training

or coming to college during COVID risk. But,

currently the study provided an evidence that the guidance and educational trials with the

staff can change their feelings positively, even

they are facingrisks. Congruent to such finding,

Harerimana and Beer in 2013, Satoh et al 2020,

Ramos-Morcillo in 2020 and Wallace in

2021found and clarified that the nurse

educators had positive attitude and perceptions

toward utilization and following CBNE,

because they found a great benefit for

themselves and for nursing students

academically and practically, during healthcare

risks. Authors mentioned that the lacking of nursing academic’s training can be a

considerable reason for their negative feedback

and perception toward such system and may

aggravate their worries toward the pandemic

situation. Therefore, staff orientation and

guidance about CBNE strategies, rules,

principles, evaluation and implementation is

necessitated, particularly with any healthcare

risks. Nursing academics should have positive

professional attitudes, acceptance and

contentment with work behaviors including using of innovative teaching strategies,

audiovisuals, evaluation tools, and curricular

management approaches. Mainly, with CBNE

as a valuable direction for nursing practice,

nurse educators have to be initiative, motivated

and gratified and be sure that CBNE is a

methodology for dealing with COVID

emergency, not a source of fear or anxiety.

(Harerimana and Beer 2013, Satoh et al, 2020,

Ramos-Morcillo 2020, Wallace in 2021)

Dissimilarly with the previous results and discussions, Salem et al, in 2018 and Ramos-

Morcillo in 2020declared that the nurse

educators have some stresses and sufferings

due to integration of CBNE quality

requirements and safety of themselves and

students in nursing practice, mainly during

clinical risk time. These stresses may affect

negatively on their attitude to follow and

adhere to CBNE methodology effectively,

particularly with COVID restrictions. CBNE

and quality measurement needs certain

standards, attributes, and preparation to

graduate expert nurses, but COVID crisis may

put some hinders. In the same time, nursing

academics requires specific acceptable

performance and hope that the nursing students

meet professional expectations, fundamentally

with CBNE. Similarly, numerous governing and accreditation organizations still need credit

hours with restricted rules and use performance

examinations for nursing graduates in using of

CBNE. Hence, qualifies nurses will face any

healthcare risks competently and the credit

hours system will be more supportede,

specially, by licensure boards by CBNE in

recruitment and license exams. (Salem et al, in

2018 and Ramos-Morcillo in 2020, Fukada

2018, Pijl-Zieber et al, 2013, Salman et al,

2020)

Furthermore, and oppositely to the current study finding, Brownie et al, 2018, Khaled in

2011and Wallace in 2021 highlighted that

particularly, in Egypt and Africa, nursing

educators found an apparent obstacle in

offering adequate facilities and equipment's in

clinical nursing practice with CBNE. Most

hospitals have a severe shortage of training

requirements. Besides, lacking training chances

and preparations of nursing educators for

competency-based teaching approaches, plus

COVID infection’ fears may produce barriers in CBNE implementation in Egypt.

Correspondingly, Bhutta et al, in 2010,

Nicholas in 2012, Satoh et al 2020, Ramos-

Morcillo in 2020 and Wallace in 2021and

Brownie et al, 2018 clarified that the nursing

curricula are mostly out-of-date and needed

modifications to match the professional

situations. Lacking of curriculum development

models is considered a remarkable challenge

among curricula developers in CBNE,

essentially with some challenges as COVID situation. The governmental view to improvee

the capacity of Egyptian nursing education and

its position between healthcare professionals is

allowing Egypt to determine the indicators of

healthcare quality and advances in the

healthcare system. Such view came in excellent

time, to face healthcare crisis competently and

confidently. Moreover, nursing academics will

find some troubles in following the authentic


144

student’s assessment which is a basic

component of CBNE and may raise some

confusion and restlessness among them. Morris

et al, in 2012, Brannick et al, in 2011and

Dashash reported that identification and

deciding of competencies' scores are very

difficult to be determined even with a checklist

in objective structured clinical examination

scores (OSCE) or in clinical or demonstration area, particularly in the COVID circumstances.

A judgment for a student's passing or failing

may be unreliable and may not determine if the

skill is ideally achieved and the competency

outcome is established or not. (Brownie et al,

2018, Khaled 2011, Wallace 2021, Bhutta et al,

2010, Nicholas 2012, Satoh et al 2020, Ramos-

Morcillo 2020)Many references illustrated that

competency assessment standardization in

CBNE is still not clear that may be a cause for

nursing students and educator’s dissatisfaction.

Therefore, to overcome the previous challenges, that may hider nursing academics

cooperation in CBNE, and affect negatively in

their acceptance to such valuable system during

the crisis time, the researchers suggested and

implemented the CBNE intervention. It

designed for encouraging and instructing

nursing academics and leaders about CBNE

development process, and curricular

establishment. Orientation and training are

essential steps for CBNE success among

nursing educators and within emergency situations. The curriculum committee and all

academics should participate in the refining of

the nursing courses to match the professional

requirements. Nursing curricula should be

updated to match the CBNE and work market

needs. Curriculum and program planning for

various self-directed instructional strategies

that parallel nursing students' pace and progress

of mastery are necessary. Accordingly, clinical

and practical preparation with enough facilities,

resources, and training opportunities are required to implement effective CBNE in

Egypt, during such emergency era.

Conclusion

CBNE instructional intervention among

nursing academics in Faculty of Nursing, Alexandria, Egypt, showed significant value

and positive impact in improving their CBNE

knowledge, planning skills and acceptance,

particularly during COVID pandemic. CBNE

concepts of competence, competency, and

authentic assessment are comprehended during

the intervention and inherited in their

organizational culture which is detected after

the intervention among experimental group.

Nursing academics have been equipped to plan

and implement the CBNE approach effectively

with nursing students during CORONA risk that was clearly reflected in their planning

skills scores, after the educational intervention.

Accordingly, CBNE awareness and

understanding among nursing academics is

clearly detected, by such educational trials

which is a necessary for nursing students

during the current pandemic time. There are

scarce experimental trials or research evidences

in such significant issue, consequently, the

incorporation, carrying out, and evaluation of

CBNE awareness among nursing educators

need continuous in-service training programs. It is a crucial issue that will be assumed in

Egypt to meet higher education, government,

and community benefits for nursing education

and nursing workforce advancement at all.

Recommendations and further studies:

There is a chronic and severe shortage in

the nursing workforce in Egypt, mainly, during

COVID pandemic. At the same time, there is a

growing in chronic and acute diseases for

adults, women, and children, and healthcare

community needs. Therefore, upgrading in the

nursing education approach is inevitable to be

CBNE. This instructional scheme requires a

comprehensive understanding of related

concepts, implementation, and evaluation

among nursing academics. Guidance is a great help for nursing academics in implementing

CBNE in Egypt. Based on the current study’

results, interdisciplinary healthcare

contributions should be carried out to develop a

comprehensive and valid insight or model

about CBNE. Teamwork among nursing

specialties and other healthcare professions

should cooperate to develop valid, reliable, and

declarative assessment tools for competency

measurement. Obtaining all literature views

about CBNE may help to implement it successfully and overcomee any challenges or

healthcare crises that may confront such

educational scheme, mainly in Egypt.

Consequently, the present review highlighted


145

some thoughts for further studies such as (1)

Assessment of CBNE implementation progress

in Egyptian colleges. (2) Evaluate the effect of

CBNE program on nursing students'

achievement, engagement, and patients'

satisfaction. (3) Replication the current study

among nursing students and academics and

evaluate achievement and compliance, mainly

during healthcare risks. (4) Using valid competency assessment tools for effective

nursing student performance. (5) Integrating

and assessing CBNE curricula in nursing

courses. (6) Using blended learning in CBNE

to decrease the consequences of COVID risk

on nursing students.

Conflicts Of Interest Disclosure

The authors declare that they have no

conflicts of interest.

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